title: Optic-guided vaginal repair of vesicovaginal fistula.
abstract: OBJECTIVE
  The transvaginal approach for the repair of vesicovaginal fistula (VVF) can sometimes be challenging, especially in fistulas located near the vaginal cuff. We describe a simple technique for the vaginal repair of VVF with the use of endoscopic optics.
  
  
  METHODS
  Three women were admitted to our department with urinary incontinence after total hysterectomy. Assessment with a clinical examination, imaging, and cystoscopy confirmed the diagnosis of VVF. All patients were operated on between December 2012 and January 2013. The operations were conducted under spinal anesthesia with the patients in the lithotomy position. Cystoscopy was performed and retrograde pyelography ruled out any ureteral damage or fistula. A 10F to 12F Foley catheter was inserted into the fistula. From this point, the operation proceeded with optic vision, mimicking laparoscopic dissection and suturing techniques using a standard 5 mm, 30-degree optic lens, a surgical monitor, and open surgical instruments. The fistula was circumferentially incised and widely mobilized from the surrounding tissues and closed without tension in two layers. A urethral Foley catheter was inserted and maintained for 14 days.
  
  
  RESULTS
  The mean operative time was 70 (range 60-80) minutes. Estimated blood loss was minimal. All patients were discharged at postoperative day 1. No complications were observed. At the postoperative first and third month follow-up visits, all patients were voiding without any urinary leakage or complaints.
  
  
  CONCLUSIONS
  The use of optics in the vaginal repair of VVF is a useful technique. Optic guidance facilitates surgical vision, dissection, and hemostasis. It is also excellent for surgeon comfort, ergonomics, and resident training.
authors.affiliation: Department of Urology, Pamukkale University School of Medicine , Denizli, Turkey .
authors.forename: Ali Ersin
authors.initials: AE
authors.lastname: Zumrutbas
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Ozlulerden
authors.forename: Okan
authors.initials: O
authors.lastname: Alkis
authors.forename: Aykut
authors.initials: A
authors.lastname: Baser
authors.forename: Zafer
authors.initials: Z
authors.lastname: Aybek
mesh_terms: D000328:Adult; D003558:Cystoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000379:methods*; D014621:Vagina / Q000601:surgery*; D014719:Vesicovaginal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*